Randomized Controlled Trial of Maternal Choline Supplementation: Effects on Infant Information Processing Speed

Abstract

Despite mounting evidence for the critical role of choline in neurodevelopment, nearly 90% of pregnant women consume choline at levels below the Adequate Intake (AI). The preponderance of this evidence for increasing maternal choline intake comes from studies with rodent models, but a recent supplementation trial manipulated the choline intake of pregnant women with a controlled diet and provided evidence that maternal choline supplementation (MCS) improves offspring cognitive functioning during infancy and at age 7. However, the only two experimental studies examining offspring functional outcomes when a choline supplement was delivered alongside a woman’s usual diet provided conflicting and inconclusive results. Therefore, it remains unclear whether widespread MCS would be an effective public health strategy for pregnant women to optimize offspring cognitive development. This thesis reports results from a double-blind placebo-controlled trial in which second-trimester pregnant women were randomized to consume a supplement of either 550 mg (n=13) or 25 mg (n=12) of choline daily while remaining on their usual diets. The Visual Expectation Paradigm (VExP) task was administered when offspring were 5, 7, 10, and 13 months of age. This visual attention task is designed to measure the latency of saccadic eye movements an infant makes toward stimuli while viewing a sequence of animations appearing on the left or right side of a monitor. These saccades are categorized as reactive or anticipatory. Infant information processing speed, a predictor of adolescent IQ, was determined by an infant’s mean saccade reaction time (RT) while the percentage of anticipatory saccades provided an index of infant visuospatial memory. Data analysis, using a pre-specified linear mixed-effects regression model, revealed that mean RT for infants in the 550 mg/d choline group was 22.3 ms faster than those in the control group (P=0.047). Percent anticipation did not differ between groups. These findings demonstrate that supplementing a pregnant woman’s diet with choline significantly improves infant information processing speed, a capacity foundational to the development of higher-level cognitive abilities.